Neighborhood level determinants of delayed HIV diagnosis among Latinos by birthplace and history of injection drug use Florida 2007 2011

按出生地和注射吸毒史划分的拉丁裔艾滋病毒延迟诊断的社区层面决定因素 佛罗里达州 2007 年 2011 年

• 批准号: 8841932
• 负责人: Diana Montserrat Sheehan
• 金额: $ 3.4万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-16 至 2017-02-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8841932
• 关键词: 13 year old; AIDS diagnosis; AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Affect; Age; American; Area; Behavior; Birth; Birth History; Birth Place; Censuses; Central America; Characteristics; Code; Communities; Community Surveys; Country; Cross-Sectional Studies; Cuba; Diagnosis; Drug abuse; Ethnic group; Florida; Gender; Geographic Locations; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health; Health Professional; Health Services Accessibility; Healthcare; Human immunodeficiency virus test; Individual; Injection of therapeutic agent; Insurance; Intervention; Latino; Life; Methods; Mexico; Modeling; Neighborhoods; Outcome; Persons; Pharmaceutical Preparations; Poverty; Prevention strategy; Public Health; Puerto Rican; Puerto Rico; Recording of previous events; Reporting; Research; Research Design; Resources; Risk; Sample Size; Socioeconomic Status; Strategic Planning; System; Testing; Time; Unemployment; United States National Institutes of Health; base; density; design; experience; health care service utilization; health disparity; high risk; injection drug use; low socioeconomic status; male; men; mortality; prevent; public health relevance; racial and ethnic disparities; residence; sex; socioeconomics; surveillance data; transmission process

 DESCRIPTION (provided by applicant): Background: Twenty percent of HIV-positive Latinos are not aware of their HIV status, and over half are diagnosed late. Persons with undiagnosed HIV infection can continue risky sexual and drug-related behavior and unknowingly put others at risk. Additionally, delayed HIV diagnosis has been shown to increase the risk of poor health outcomes and HIV-related mortality. Predictors of delayed HIV diagnosis among Latinos include older age, male gender, injection drug use (IDU), foreign birthplace, and low educational attainment. Studies suggest that neighborhood characteristics may also predict healthcare utilization and health outcomes and partially account for racial/ethnic disparities. Moreover, studies show that neighborhood factors, independent of individual factors, also predict HIV seroconversion and high-risk injection behavior among IDUs. Objective: The objectives of this study are to (a) examine the relationship between neighborhood characteristics and delayed HIV diagnosis among Latinos of varying origins, and (b) identify the potential moderating effects of IDU on these associations. Specifically, the study will examine the impact of neighborhood-level socioeconomic status (unemployment, poverty, and educational attainment) and ethnic density on the timing of HIV diagnosis among Latinos by country or region of birth. Design: The study will use a cross sectional study design to study Latino individuals [13 years and older] reported with HIV infection between 2007 and 2011 to the Florida Department of Health HIV/AIDS Reporting System. The American Community Survey conducted by the U.S. Census Bureau will be used to determine neighborhood characteristics. Cases will be matched to neighborhood characteristics based on the zip code of residence at the time of HIV diagnosis. The total sample size is [5,899]. Analysis: Mixed/random effects modeling will be used to determine the effect of neighborhood- level factors on delayed HIV diagnosis. This method will account for non-independence (spatial correlation) within and between neighborhoods. An interaction term between neighborhood-factors and injection drug use will be added to the model to test for IDU as a moderator of the relationship between neighborhood-factors and delayed HIV diagnosis. Analysis will be stratified by country/region of birth to account for the large socioeconomic, educational attainment, and health care access variability among Latinos of varying origins as well as the differences in history of IDU. Significance: [The results of this study will help identify possible structural barriers to and facilitators of HIV testing among Latinos of varying origins. This information will assist public health professionals to appropriatey target resources and design more effective and culturally competent interventions to decrease the risk of delayed HIV diagnosis among Latinos.] The aims of this study are parallel to NIH/NIDA's strategic plan to decrease health disparities of HIV/AIDS, prevent HIV transmission, and better understand the interaction of drug abuse and HIV/AIDS.

 描述（由申请人提供）：背景：20%的艾滋病毒阳性拉丁美洲人不知道他们的艾滋病毒状况，超过一半的人被诊断为晚期。未确诊的艾滋病毒感染者可能继续进行危险的性行为和与毒品有关的行为，并在不知不觉中使他人处于危险之中。此外，延迟艾滋病毒诊断已被证明会增加不良健康结果和艾滋病毒相关死亡率的风险。拉丁美洲人延迟艾滋病毒诊断的预测因素包括年龄较大，男性，注射毒品使用（IDU），外国出生地和低教育程度。研究表明，邻里特征也可以预测医疗保健利用和健康结果，并部分解释种族/民族差异。此外，研究表明，邻里因素，独立于个人因素，也预测艾滋病毒血清转换和注射吸毒者的高危注射行为。目的：本研究的目的是（a）检查邻里特征和延迟的艾滋病毒诊断之间的关系，不同起源的拉丁美洲人，和（B）确定潜在的调节作用，IDU对这些协会。具体而言，该研究将研究社区一级的社会经济地位（失业，贫困和教育程度）和种族密度对拉丁美洲人出生的国家或地区的艾滋病毒诊断时间的影响。设计图：本研究将采用横断面研究设计，研究2007年至2011年期间向佛罗里达卫生部HIV/AIDS报告系统报告感染HIV的拉丁裔个体[13岁及以上]。美国人口普查局进行的美国社区调查将用于确定社区特征。将根据艾滋病毒诊断时居住地的邮政编码将病例与社区特征相匹配。总样本量为[5，899]。分析：将使用混合/随机效应模型来确定社区水平因素对延迟HIV诊断的影响。该方法将考虑邻域内和邻域之间的非独立性（空间相关性）。邻里因素和注射毒品使用之间的相互作用项将被添加到模型中，以测试IDU作为邻里因素和延迟HIV诊断之间关系的调节剂。分析将按出生的国家/地区分层，以解释不同出身的拉丁美洲人之间较大的社会经济、教育程度和医疗保健获取差异以及IDU历史的差异。意义：[结果] 这项研究将有助于确定不同出身的拉丁美洲人中艾滋病毒检测的可能结构性障碍和促进因素。这些信息将有助于公共卫生专业人员适当的目标资源，并设计更有效和文化能力的干预措施，以减少拉丁美洲人延迟艾滋病毒诊断的风险。这项研究的目的是平行的NIH/NIDA的战略计划，以减少艾滋病毒/艾滋病的健康差距，防止艾滋病毒传播，更好地了解药物滥用和艾滋病毒/艾滋病的相互作用。